Changing Epidemiology and Antifungal Susceptibility Patterns of Candida Species Isolated from Ghanaian HIV-Positive Patients

Abstract

The most common type of fungaemia, candidaemia is caused by Candida spp. There is an alarming emergence of resistant strains of Candida spp. to antifungal treatment patterns. In this study, candidaemia among Ghanaian HIV/AIDS patients was compared to a similar study in 2008 to ascertain the changing prevalence of different Candida spp. and novel susceptibility patterns to the common antifungal drugs; amphotericin B, clotrimazole, ketoconazole, fluconazole itraconazole and nystatin. From 2010 – 2014, a total of 176 Candida spp. (including 15 non-speciated isolates) were obtained from HIV positive individuals. The species were isolated and identified by culture on Sabouraud agar, sugar fermentation, assimilation, urease production tests and confirmed by mini API bioMerieux analyzer. Comparing the two studies over the nine-year period, though not statistically significant (p=0.362), we observed that the incidence of Candida albicans reduced by 9.1%, whereas Candida tropicalis, Candida parapsilosis, Candida glabrata and the non-speciated increased in incidence by 3.6%, 1.7%, 3.3% and 3.1%, respectively. Similarly, amphotericin B (p=0.071) and clotrimazole (p=0.261) despite observable declines in susceptibility of isolates showed no significant decline in drug potency. There was significant increase in resistance of isolates to commonly prescribed antifungal agents; itraconazole (p=0.003), fluconazole (p=0.000), ketoconazole (p=0.008) and nystatin (p=0.049). Most probably, treatment failure of candidaemia among HIV positive individuals on antiretroviral therapy is increasing.